介護老人保健施設の看護・介護スタッフによる日常生活における自己決定支援の積み重ねが認知症高齢者に及ぼす効果

Effect on Elderly People with Dementia of Self-determination Support in Daily Life Built Up by Nursing and Care Staff at Long-term Care Health Facilities

抄録

　本研究の目的は，介護老人保健施設における看護・介護スタッフによる自己決定支援の積み重ねが，認知症高齢者に及ぼす効果と支援実施の課題を明らかにすることである．介入実施者であるスタッフ27人が，間食・更衣など4つの活動場面で認知症高齢者に行動の選択肢を提示し，選択理由をたずねる支援を8週間実施した．評価項目は認知機能検査（MMSE），前頭葉機能検査（FAB），精神機能障害評価票（MENFIS），QOL評価尺度（DHC）得点として，ベースライン期間，介入期間，フォローアップ期間での群内前後比較で評価した．

　分析対象となった認知症高齢者16人への平均介入回数79.6回，実施度63.5％であった．介入前後のFAB（p＝0.007），MENFIS（p＝0.014），DHC（p＝0.005）が有意に改善した．スタッフからみた認知症高齢者の変化は『「ありがとう」ということばが増えた』『選択の機会があることで笑顔がみられた』などであった．日常生活における自己決定支援の積み重ねが，認知症高齢者の生活によい影響を与えることが示された．

　This study aimed to clarify the effect that the build-up of self-determination support by nursing and care staff at long-term care health facilities had on elderly people with dementia and the challenges of implementing this support. Twenty-seven staff members performing interventions provided 8 weeks of support in which they presented a choice of actions to elderly people with dementia in four situations including snacking and changing clothes, and asked these elderly people why they made their particular choice. The endpoints were Mini-Mental State Examination (MMSE), frontal assessment battery (FAB), mental function impairment scale (MENFIS), and Dementia Happy Check (DHC), which were evaluated by intragroup comparisons between scores at baseline, during intervention, and during follow-up.

　The 16 elderly people with dementia who formed the analysis set underwent a mean number of 79.6 interventions with an implementation level of 63.5%. When compared with before the intervention, significant improvement after the intervention was seen for the scores for FAB (p = 0.007), MENFIS (p = 0.014), and DHC (p = 0.005). Changes in the elderly people with dementia perceived by the staff included “an increase in the words ‘thank you’” and “smiles were seen when an opportunity for choice was presented.” These results demonstrate that a build-up in self-determination support in daily life has a positive effect on the lives of elderly people with dementia.